• Maintain a fully automated claims adjudication system in compliance with electronic transmission standards and security requirements and all other regulations as required by HIPAA, provide WEB access to plan participants that allows for claim status and offers various customer service functions. • Maintain records and management reports, including claims and accounting information, as required by the contract. • Provide a timely response to inquiries from plan participants and providers regarding eligibility and status of claims, correspondence, payment, and any other information requested by such parties in a manner that will limit the County’s involvement in dayto-day inquiries. • In consultation with County HR Staff, prepare and print summary plan documents, claim forms, and any other communication material as required by the contract. • Employee insurance ID cards shall be provided by Respondent and shall be mailed by Respondent to the employees’ home addresses. • Deliver utilization reports. The County needs to access standard reports online, preferably in excel format. • Provide online access to additional standard or ad hoc reports as needed by the County. If a specific report cannot be generated online, prepare and provide such to the County electronically. • Meet with representatives of the County’s Human Resources Department as often as deemed necessary by the County. • Attend annual Open Enrollment each year. Tentatively scheduled this plan year for August 21, 2025 through August 22, 2025. The Respondent may be required to give oral presentations regarding the plans offered to County employees.
